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SERI -- CPT Information

SERI - CPT Question or Comment?

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These responses are regarding how services are submitted from the RSN to DBHR.
Please consult with your RSN to determine any additions to their specific data needs.

 

Q.  Should Evaluation & Management Codes be submitted with a minute value, or a single unit value regardless of the number of minutes?

A.  RSNs should report as one unit to DBHR.

 

Q.  How is a service provided prior to January 1, 2013, but reported after December 31, 2012 to be reported—old code or new code?

A.  Submit the “old” code(s).

 

Q.  Can a master's level professional perform and E&M service and submit and E&M code?

A.  No.  E & M codes are intended only for specific medical staff use.
CMS guidelines for E & M coding can be found at:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf 

 

Q.  Can a PhD level person perform an E & M service and submit an E & M code?

A.  No.  E & M codes are intended only for specific medical staff use.
CMS guidelines for E & M coding can be found at:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf

 

Q.  Part 1 - How would a scenario with multiple appropriate service codes be documented in a chart?
(i.e. a scenario with an E & M code, a 90785 code and an add-on code like +90833)?

Q.  Part 2 - With E & M codes being duration specific and the add-on codes having a specific duration as well, do the services overlap in duration or do they need to be separated?

Q.  Part 3 - If you provide an E&M service starting at 8am for 10 minutes and have the add on 90833 for 20 minutes; do you use the same start time for both codes?  So it would be E&M from 8 am - 8:10 and 90833 from 8am - 8:20am. However you provided a 30 minute service.  Or...Do you document the service as E&M 8am-8:10 and 90833 8:10am- 8:30am? 

A.  (To part 1, 2 and 3)
- E&M codes are not duration specific.  Please refer to E&M guidelines in the CPT manual. Also, check to see what your RSN data system will accept and their documentation policies and procedures related to submission and encounter data validation.


-Each service must be “significant and separately identifiable” per guidelines and documentation; therefore, documentation must support the distinct services (time and complexity) for each code submitted. DBHR recommends a multi-part note, one for each submitted code, with one signature; however we understand that data systems may require separate services therefore separate notes.



Q.  Is ProviderOne requiring the reporting of the psychotherapy add-on codes (+90833, +90836, +90838) in a separate service line with the E & M code within a single claim? Or can the E & M code and the Add On Code each be reported as a separate claim?

A.  The new add-on and E&M codes can be sent as second or third procedure codes on the same claim or independently as separate claims.  They will all be processed and supported.

 

Q. Is the state planning on removing any E & M codes that are currently available
(i.e. 99201—99205, 99304—99306, 99324—99328, 99211—99215)?

A. Not at this time.  

 

Q.  What are the rules around documenting Day Support services when a client may have Interaction with numerous staff, attend groups as part of the Day Support service and have other appointments during the Day Support hours?  And, does the staff documenting the service have to be a specific provider type/degree?

A.  All services provided during a Day Support “day” by that program staff can be recorded by a single staff.   The “day” can be documented in a single note but should not include any service (description or duration) provided during the day that is by non-Day program staff, which should be recorded and encountered separately.

As defined in the Day Support Service Modality in the SERI, the documenting staff must be, or be supervised by, a Mental Health Professional and be one of the following provider types:  MA/PhD, Bachelor Level with Exception/Waiver, Mental Health Specialist, Certified Peer Counselor, Master Level with Exception/Waiver, Below Master’s Degree, Other (Clinical Staff Person)

 

Q.  Will add on codes be excluded from state and EQRO when pulling encounters for Encounter Data Validations or other reviews?  If these services are not excluded from these reviews, they will pull empty note that refers to documentation within another note, if the providers document all services for that encounter within one note.  For example: a prescriber spends 30 minutes on a 99214 and has an add on of 30 for 90833 and includes the code 90785 for interactive complexity, but documents everything under one note that is attached to the 99214. Then EQRO comes and pulls random encounters to review and pulls the 90833 as their random, but the note says to reference the OTHER note.  Will the RSN not pass that encounter?

A.  Documentation needs to support the service provided whether it’s in one note or multiple notes.  Any data pulls must contain the primary and add on codes for an accurate picture of the service(s) performed.


Q.  What is the current name of the program formally referred to as DMIO or CIAP?

A.  The former DMIO and CIAP Program has been renamed to Offender Re-entry Community Safety Program (ORCSP)

 

Q.  A question about the upcoming 1/1/2013 CPT changes and the "+" codes.  Are these services to be submitted, literally, with the "+" sign in front of them?  In other words, CPT code "+90838"?  Or does the "+" simply indicate that the code "90838" will be submitted in addition to the other code for the service?  (I assume, on a separate service line, with "90838", for example, as the CPT?)

A.  No, do not include the + sign despite what is found in the document at:
http://www.dshs.wa.gov/pdf/dbhr/mh/Additional%20Explaination%20--%202013%20CPT%20Codes%20Changes.pdf"

 

Q.  In going over the New CPT’s that are effective January 1, 2013, we have a few questions. For Crisis Services – 90839 with add on code 90840 its in the crosswalk produced by the DBHR SERI workgroup it indicates that only psychiatrist/MD/ARNP and PA’s are allowed to do this service. In the new CPT Manual it does not indicate that is the case, in that anyone can do this code. We are wondering if this was an oversight or not?

A.  DBHR decided to exclude these two codes as these activities can be captured under existing codes.

 

Q.  For clinical Intakes – not provided by Psychiatrist/MD/MA/PHD/ARNP/PA in the new 90791 intake value – are we to continue to report the H0031?

A.  Non licensed MHPs should use H0031.

 

Q.  Part 1 - I have a site that wants to know what they will need to use for a 90801 with the modifier of ‘53’ (interrupted procedure). The information I’ve received doesn’t really specify what would be appropriate.

Q.  Part 2 - There is some confusion about service modifiers.  For example, 90801 will be discontinued, and providers used to be able to submit this with code "53" (for "discontinued procedure").  Now that there are 90791 ("without medical services") and 90792 ("with medical services") are the service modifiers still in effect? In other words, might we get a 90791:53 or a 90792:53?  Or is "discontinued procedure" the same thing as the difference between 90792 and 90791?

A.  (To part 1 and 2)
Modifier 52 and 53 will still be valid for all services under intake modality.

 

Q. If a provider has a consumer come in for family services and mom cannot attend in person but is available by phone. The MHP is facilitating the discussion between mom and consumer and work is documented in the treatment plan and progress notes. Should the session be billed as Family therapy? The modality states that the “Service is provided with family members and/or other relevant persons in attendance as active participants” Is the phone considered in attendance or should it be an individual service?

A.  Yes. This is considered family therapy.  Progress note must include family member participation via telephone.

 

Q.  Can a therapeutic intervention occur within a car?

A.  Yes. Documentation in the progress note must support the therapeutic intervention.  The location of the therapeutic intervention should be reported as “other” location.

 

Q.  Currently when there is an interpreter in the session, the clinician will bill the code and also bill a T1013 for the same time period, indicating that an interpreter was present.
With the new codes, do the clinicians need to code T1013 for interpreter AND 90785? Or will the interactive complexity add-on be sufficient?
     
A.  When an interpreter is used for a service, report primary code, add on code, and interpreter code.

 

Q.  What code should a practitioner use if they are the first person to engage the client? H0023 requires an authorization.

A.  H0023 or H0023-HW do not require an authorization and can be provided prior to an intake. Use appropriate code dependent upon location of client.  See Modality/Service definitions for further clarification.

 

Q.  If the person is not open to outpatient services– do we have to perform and intake prior to providing Rehabilitation Case Management?

A.  No.  You do not have to provide an intake prior to rehabilitation case management.

 

Q. Will this single code be the only code that can be used for Rehabilitation Case Management?

A. RCM is reported with H0023 - No modifier. 


Q.  If we use multiple codes how will you tell it is RCM?

A.  Lack of HW modifier will identify the service as RCM


Q.  Can they provide Rehab Case Management services prior to Intake?
 
A.  Yes. This is currently in the SERI Rehab Case Management inclusion list.


Q.  Can our providers complete an intake while a person is in a 24/7 facility? 

A.  Yes.  If coded as a Rehab Case Management.


Q.  Part 1 - If you provide an E&M service starting at 8am for 10 minutes and have the add on 90833 for 20 minutes; do you use the same start time for both codes?   So it would be E&M from 8a.m. - 8:10 and 90833 from 8 a.m. - 8:20.  However you provided a 30 minute service.  Or do you document the service as E&M 8am-810 and 90833 8:10am- 8:30am?

Q.  Part 2 - I just wanted to seek clarification on start times for services with add-ons.  
The two services would not overlap correct? Each would have its own start time?

A. (To part 1 and 2) 
-The same start time may be used depending on your data system requirements; however, please inform your RSN how your service will be recorded.
-Documentation needs to support the service provided whether it’s in one note or multiple notes.  Any data pulls must contain the primary and add on codes for an accurate picture of the service(s) performed.

 

Q.  For follow-up medication visits, we no longer have 90862, the code most commonly used by our providers for these services.  Instead we are asked to use an E&M code (OR a combo of an E&M code along with a psychotherapy code, depending on whether or not psychotherapy is part of the visit, which is usually not the case).
Unlike the old 90862, the allowed E&M codes are all location-specific.  There is a group to use for visits that are in the office (or other outpatient facility), a group for use in nursing homes, and a group for use in residential facilities.
So, the question is: how do you code a follow-up medication visit that occurs in a home?  I am specifically thinking of a visit that, were it in an office, would meet all the coding requirements for using the E&M office codes.

A.  If appropriate, use T1001 for nursing assessment/evaluation in a client home. Additional 99341-99350 CPT series (home codes) will be added to the revised SERI.



Q.  90838UA - I am a little confused by this code. The UA modifier designates services under a BRIEF AUTHORIZATION, this is an ADD-ON code to an E/M service which is not covered by a BRIEF AUTH TYPE basically, that code is not allowable in the brief authorization and so cannot be used with a UA modifier, correct?

A.  The brief intervention treatment refers to a span of time that contains one or more services that may or may not be brief in duration.  All services listed under Individual Treatment Services, Family Treatment and Group Treatment Modalities may be listed with the UA modifier. 


Q.  Are add ons submitted as a unit or by minutes?

A.  RSNs should report as one unit to DBHR.

 

Q.  Part 1 - Can you clarify how the prolonged service codes are used?
Q. 
Part 2 - The CPT manual states that for 90837 you record 1 unit if 53 minutes + (read page 485 of CPT manual – regarding Psychotherapy).  The encounter rules indicate the previous code (90808) which was 75+ minutes was defined as an 80 minute unit.  So – if the 90808 was 160 minutes it would encounter with 2 units.  Is this still the intention meaning a 90837 for 120 minutes would encounter with 2 units or is the interpretation any service over 53 minutes would encounter with one unit?

A.  (To Part 1 and 2) - Prolonged E&M service codes are not in the SERI.  If you go past the upper duration (68 minutes) in psychotherapy, H0004 should instead be used for a long duration service. e.g. for a 74 minute service, report H0004 with 5 units of service.

 

Q.  Who (what provider types) can do the interactive therapy (90785) add on code? 

A.  The rules for the add on codes follow the rules for the primary code.

 

Q.  I recently received documentation that stated if there was an E&M code submitted by a prescriber and the prescriber wanted the nurse to draw blood or take blood pressure etc.. that these service provided by the nurse are a part of the E&M service. So what code would the nurse submit, for that activity, since it appears they could not submit the 99211? 

A. This is a part of the E&M service provided by the provider and should not be reported as a separate service.

 

Q.  Part 1 - We are seeking clarification on mental health serviced in a residential setting and the MHCP.  The SERI states: "Mental Health Care Provider (MHCP) is located on-site a minimum of 8 hours per day, 7 days a week."  Does this mean that the MHCP is located at every facility this is provided?
Q.  Part 2 - Could one MHCP be available at two adjacent facilities (example: two apartment complexes or houses that are side by side)?
Q. 
Part 3 - Could a facility be across town and an MHCP be available by phone as needed?

A. (To part 1 and 2) -  Yes.  If a facility can be defined as boarding homes, cluster housing, supported housing, or SRO apartments as outlined in SERI.

A. (To part 3) - No.


 

Q.  In the November 2012 SERI these individual treatment services codes:
90804, 90806, 90808, 90810, 90812, 90814, 90816, 90818, 90821, 90823
List these valid provider types:
Psychiatrist/MD,ARNP/PA,RN/LPN,MA/PhD

The 2013 replacement codes (90832, 90834, 90837) do not include RN/LPN as a valid provider type. Was this intentional? If so, please provide an explanation that I can pass on to our providers.

A. Yes. This was intentional.  90832, 90834, 90837 are individual psychotherapy codes.  Psychotherapy is usually performed by a physician, ARNP, PA, Masters level MHP and not by an RN or LPN.  


 

Q.  The current version of the 2013 CPT Code Crosswalk now shows 90839/90840 as valid codes. Previous versions had these crossed out with this note: “Continue to use crisis codes as per current SERI. DBHR will not be adopting 90839 or 90840 for use in 2013.” I just want to verify that this has changed and DBHR will be adopting 90839/90840.

A. No. DBHR will not be adopting 90839 and 90840 codes. These have been removed from the 2013 crosswalk.


 

Q.  This is from page 484 of the 2013 CPT code manual:
Codes 90791, 90792 are used for the diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day.
Will ProviderOne and/or DBHR be enforcing this rule? If so, I would want to modify our RSN data system to enforce it as well.

A. No. National Correct Coding Initiative (NCCI) edits are not being applied to RSN encounters in Provider One.  There are no plans to add these into the DBHR/CIS.


Q.  I had a question today from a provider.  They are reporting High Intensity Treatment.  They are being asked to report CFT as well.  The High Intensity modality does not call out CFTs one of those services that can be provided concurrently (that work is really sort of embedded within the modality and by the staff who are assigned to the team).  So there are essentially 2 questions.
- Can the meetings be reported in addition to the Per Diems?
- This particular agency does not bill a per diem on a day when there was no client contact with or on behalf of a given client.  If they do have a contact, then they will submit a per diem for the client.  If not, then they do not.  So, if the CFT is the only contact with the client for the day, will that be considered “double reporting”?  Or should both be reported because DBHR wants the team frequency info on the client regardless?

A.  No.  If they are in a per diem program report the per diem.  Do not report the CFT.

 

Q.  Stabilization Modality is used for stabilization services 24+ hrs (S9485). Crisis Intervention MH services Code  is for anything  less than 24 hours of services(H2011). At our RSN the 24 hour stabilization is not provided within the Crisis Service department.
While a client is receiving the 24 hour Stabilization, the Crisis Services staff, DMHP, may be asked to re-evaluate the client for a higher level of care.
1.  What is the most appropriate code for the DMHP to use when a S9485 (stabilization code) is being used?
2.  If a client goes into a 24 hour stabilization unit at 5 am, is the stabilization unit supposed to use H2011 or can they use the S9485?

A. The SERI is currently under revision and this modality will be clarified.



Q.  Would an assessment that involves a MHP and a CDP be acceptable?

A. The MHP needs to record this service.



Q.  On the SERI FAQ there is this statement: “Additional information is currently under review related to the 99341-99350 CPT series.” Our providers want to know if these codes are going to be adopted. If not, what code should they use for a home visit?

A. The revision to the current SERI will include this series and you may begin submission of these codes upon the effective date of the newly revised SERI.

 

Q.  Some of our providers code crisis services in their systems using 90839/90840 and they plan on converting them to H2011 before sending them to the RSN. How should they do this conversion? H2011 represents 15 minutes of service. Suppose our provider has one 90839 and one 90840 in their system for a particular crisis service. Would they be able to submit this?
H2011    4 UN
H2011    2 UN 

A. This would depend upon the RSN/provider contract.  The provider should know the duration of each service and report the units accordingly.

- With this approach they convert each code separately: 90839 becomes H2011 4 UN and 90840 becomes H2011 2 UN. This means there would be two service encounters for this client on the same day with the same HCPCS code – is this allowed?
A. Yes.

- If not, I assume they would have to submit this:
H2011 6 UN

A. This is acceptable as well.

- I suppose another approach would be for our providers to submit 90839/90840 to the RSN and then have the RSN do the conversion before submitting to DBHR. Would that be acceptable?

A. This would depend upon the RSN/provider contract.

 


Q.  For crisis/DMHP work for these 3 activities where would you expect the location to be coded- receiving the call and taking in the information, the evaluation of the consumer, and then write up and follow up phone calls?

A.  Location is always based on staff location at time of service.

And another scenario:
Receiving the phone call, Eval by ED social worker, and write up and follow up phone calls by DMHP but no face-to-face evaluation.

A.  Location is always based on staff location at time of service.

 

Q.  In regards to crisis services- Does the secondary safety staff encounter their service using the UC modifier as well as the DMHP? Or is there only one encounter submitted?

A.  No second encounter.  Use the UC modifier to indicate multiple staff present.

 

Q.  The CPT code book  states" do not report 96372 for injections given without direct physician or other qualified health care professional supervision. To report, use 99211".  Does this mean the physician or other  qualified health care professional  need to be onsite or  can just be accessible or other?

A. Medicare requires the professional to be on site.

 

Q. A consumer comes in for their psychiatric apt. 99212. The consumer is present. The primary therapist is also present to consult with the specialist (psychiatrist).  Could that session be coded the following way?
Psychiatrist 99212
Primary therapist H2015
We are asking because in the individual treatment service modality in the inclusion section it states “Specialist consultation between the specialist and the clinician.”   In addition, under the medication management modality an inclusion is “Consultation with collaterals, primary therapist and/or case managers.”  We would pay if the primary therapist and the psychiatrist are from 2 different RSN funded agencies. Can we pay if they work for the same agency?

A. If they work for the same agency, and client is not present, neither one can report.  If they work at different agencies, and the client is not present, both could report under Comprehensive Community Support Service.  If client is present and if at the same agency, only one would report, if separate agency, provider with the client would use the appropriate code and the consulting provider would use Comprehensive Community Service.

 

Q. Our provider agencies have asked if performing T1013-Interpreter Services via Telehealth (GT modifier) was considered when the Telehealth section was added to the revised SERI?  If not, if this Telehealth service can be considered as a valid service by DBHR at this time? 

A. Interpreter services should not be reported as Telehealth with the modifier. 

 

Q. Many of the service codes in the revised SERI make reference to a typical duration, such as 99205: “Office or other outpatient visit…for a new patient….  Physicians typically spend 60 minutes face-to-face with the patient and/or family.”  I was wondering if the DBHR provided this information in the SERI simply for advisory purposes, or if it is intentional with regard to RSN’s submitting their data to the State around these parameters (meaning DBHR will accept or reject services based on these typical durations)

A. The wording came directly from CPT manual around “typical.”

 

Q. Respite- I noted that this is again in the SERI – are you paying for this again with Medicaid funding or is this still only available with state or local funds? 

A. Due to the termination of Medicaid funding for B3 services, this is no longer a covered Medicaid service.   The SERI will be updated to reflect this change.

 

Q. Question:  Client at facility receiving 24 hour stabilization services.  During one of the interim days (interim = not admit or discharge day), the client receives a 1.0 hour Individual Therapy session at 10:00am with their primary clinician. 
To document the encounter(s):
a)  Submit S9484 Stabilization service for 12:00am - 11:00pm (23 hrs.) & Individual Service for 10:00am-11:00am (1 hr.), or
b)  Submit S9484 Stabilization service for 12:00am - 10:00am (10 hrs.) & Individual Service for 10:00am-11:00am (1 hr.) & S9484 Stabilization service for 11:00am - 11:59pm (13 hrs.), or
c)  Submit S9484 Stabilization service for 12:00am - 11:59pm (24 hrs. since Stab services were available to the client 24/7) & Individual Service for 10:00am-11:00am (1 hr.)

A. Dependent upon how you are encountering your stabilization services, each encounter should be documented separately.  If you submit three 8 hour shift services, each 8 hour encounter should be reported separately with appropriate provider type and have its own distinct note.  If you submit one 24 hour service, that would be one note documenting all activities and staff information.  In this case, “other” provider type (12) would be acceptable.

We suggest you discuss with your RSN and providers to develop an agreed upon submission standard.

Q.  In a reporting environment that only allows one CIS provider type per encounter, when a provider holds multiple CIS provider type credentials which one should be reported? (Historically it has been the highest CIS provider type held)

A.  Usually it is the highest credential – however if also a Certified Peer Counselor and the 06 type is allowed on that specific service then the 06 should be used.

Q.  If it continues to be the highest, given the new requirements which CIS provider type would be classified as the highest? i.e. a provider holds 04 and 06 credentials.

A.  See answer above.   
If the provider is employed as a ‘Peer Counselor’ the services should reflect that unless they are performing a service not allowed in the SERI for Peer Counselors.
(Peer (06) is allowed in Day Support, Limited HCPCS for Individual, Medication Monitoring, Peer Support, Rehab Case Management, Therapeutic Psychoeducation, CF Team Meeting, Engagement and Outreach, Interpreter, Request for Services, Respite, Supported Employment, Community Based Wrap Services, Community Transition (Jail)).


Q.  If a client checks into a Stabilization facility at 11.30 pm, how shall we report that half hour for that date of service?

A.  Since there was only 30 minutes for the current day, that ½ hour should be recorded as crisis, and then the clock starts again at Midnight for the next day.